Provider Demographics
NPI:1417186966
Name:RAYMOND, CAROLYN (OT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 MONTE VISTA AVE
Mailing Address - Street 2:#1D
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4581
Mailing Address - Country:US
Mailing Address - Phone:510-922-9604
Mailing Address - Fax:
Practice Address - Street 1:344 MONTE VISTA AVE
Practice Address - Street 2:#1D
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4581
Practice Address - Country:US
Practice Address - Phone:510-922-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist